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The second curve indicates the average haemoglobin level in each ace
group and is based on the findings in a hundred infants aged 12 months, a hundred
aged two years fifty aged three years, fifty aged four years and ten aged five years
A study of each group shows that 36 per cent, of the one-year-old infants 27 per
cent. of the two-year-old, 20 per cent. of the three-year-old children and 15 per cent.
of the four-year-old children must be considered anaemic in that the
haemoglobin level fell below the lower limit described. Probably most haemotologists
would stipulate a higher standard of normality and this would entail an
incidence of anaemia double that described. Severe anaemia was found to be
uncommon after three years of age and even mild anaemias became uncommon
after four years of age. Anaemia thus tends to disappear as children grow older.
This improvement coincides with the beginning of adequate mixed feeding. The
normal method of treating these anaemias is therefore to begin mixed feeding
earlier than hitherto and a diet sheet has been made out. This diet is in no way
final and will be modified from time to time. It is urged that when a dried milk
is used in infant feeding a brand should be chosen which contains added iron.
In the cases of marked anaemia iron has been administered and no case
now remains in the severely anaemic group. This result emphasises the predominating role of iron deficiency in the production of these anaemias. Finally
the numbers of blood examinations are now large enough to show that the average
I< ? V | t ; ° f tht : Camberwell and Peckham children is lower than that of
the Dulwich children.In Camberwell, the incidence of anaemia is higher. This
fact together with the finding that the Camberwell children were also smaller
does suggest that inadequate feeding is more common in this poorer district.
Rickets.
The third manifestation of inuate nutrition which must be discussed
is rickets. Twenty years ago severe rickets was common. To-day. it is uncommon.
wen "tI?,! Tr+ gS iw X , etC ''.?/ the advanced condition are now seldom
seen. The possibility that rickets is still prevalent in a mild form must be borne
in mind and warrants full investigation in doubtful cases. It is, however the
wide experience of paediatricians that in the majority of children diagnosed as
rachitic the diagnosis is not confirmed by radiology and bio-chemical tests. Five
oi the children examined at this clinic were so investigated. Clinieallv rickets
was suspected but the diagnosis was not confirmed. It is possible, however that
?wLwk ' W . lch - h , aVe be T full >' instigated had already passed
through the period of active rickets and that at the time of the investigation the
disease had been cured In the quiescent stage the laboratory tests are negative
although the bone deformities may persist. It is probable that active rickets
may develop, do its permanent damage, and then heal in a period of a few months.
It would be satisfactory if facilities could be supplied so that this clinic might
help m deciding this question. As a preliminary experiment fifty of the one-year
infants might be kept under close observation. X-rays of the'wrist and b'lood
phosphatase estimations could be made every two months. In this wav active
rickets of short duration could not very well escape recognition. The investigation
might show that rickets is not so rare as we think, and this finding would entail
a tightening up of anti-rachitic precautions. In the present series of children
healed rickets was suspected in fifteen cases. Early active rickets was detected
in one case.
Body Weight.
The limitation of body weight as an index of health has already been
stressed. Also the fact that a small puny child constitutes a challenge to the
physician to find the cause which is not always an inadequate diet. Some observations
on body weight have however been made and it is significant that at each